The big question: are hospitals outdated for ageing patients?

Shadow health secretary Andy Burnham has warned that NHS hospitals are designed for the needs of the previous century and are in danger of being overwhelmed by the needs of older patients.

Mr Burnham said these reasons were at the “crux” of the problem why stories of older patients being neglected or abused were recurring with “ever greater frequency”.

He said his “penny drop” moment came after speaking to a sister at the Royal Derby Hospital, who told him wards were no longer designed to deal with the complexity of the “demographic challenges of this century”.

Are nurses stretched because hospitals are not set up to care for an ageing population with complex needs? What do you think?

Your comments could be published in Nursing Times.

Readers' comments
(4)

As with any question, the first order of business is to perform a good literature search. Look at the demographic past and present. Look at payer differences. Look at acuity, staffing comparisons and any other variables that come into play. Reliable and valid data and conclusions depend upon good methodology by authoritative researchers.

There was a shift quite a few years back to move older people out of 'geriatric wards', then close these wards down, so that care could be delivered back in the 'community'. Some of these wards, included patients doing the tea rounds, helping other patients and doing a great deal more socialising on the wards. Also turn around times for surgical patients increased, where hospital stay was greatly reduced, and rehabilitation increased. Elective surgery turnover times was even more noticeable, with day-surgery introduced. Don't think the medical wards were looked into much.Shouldn't the penny drop moment include the thought that it is not a good idea to close or reduce acute hospital services and resources, without having resources, training and investment already in place within the community to look after people. By cutting first, we're left with shortages in hospitals and in community care.If we can't get staffing/skill mix to patient numbers right, how will we get it right with patients of differing and changing levels of acuity (such as 1 staff looking after a reasonably well patient, becoming 4 as a person deteriorates and its a struggle to move them into the right position). In the community, hoists are a bit difficult to get hold of. Nursing levels are stretched everywhere; for better care we need more nurses.Colleagues from abroad have expressed concerns that older people here are left in 'old people farms' and without family support, which wouldn't be dreamed of, where the culture is that older people are more respected and looked after by family and their community. [May be another study on that? ;oP ]

I go to my own experience on this. I grew up as a child with grandparents having their final illnesses in our home - with brief episodes in hospital. They were all mobile and independent until shortly before death.

In the last decade I experienced my mother's final illness which lasted 8 years. She survived strokes - but this meant she had dementia. The drugs prevented her from having more strokes, and when she needed surgery at the age of 88 the surgical techniques were effective in giving her another 4 years of life with a colostomy.

What did not work so well is that she lost her mobility when in hospital, and there was no community care that could deal with the colostomy and allow her to get back to her flat. So her last 4 years were in a nursing home where she did not want to be.

I believe that Andy Burnham has understood very well the complex mixture of services that are going to be needed to look after the very frail elderly in their 80s & 90s.

Our health and social care services - and sometimes even the buildings that we use are not serving our increasingly frail elderly well. This is at the heart of the problems that we have experienced where I live in Stafford. I am glad that there are many people in Stafford now who recogise that we do need a really creative response to this challenge.

I think it is important that Andy Burnham has recognised that Staff and Patients working together are essential in being able to make this response.

I didn't think it was ward design/outdated hospitals that was the issue but staffing levels - didn't the Charge Nurse who gave him his 'penny drop' moment say that staffing levels hadn't adjusted to cope with the demands of aging patients.

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